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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Ultramar Sampling Date: 9"13 `Oj6 <br />. Site: Beacon #695 Project No. : 94-69/n15-01 <br /> 900 S. Cherokee Lane Well Designation: Whb-A W-1 <br /> Lodi, CA <br /> Is setup of traffic control devices required? o YES time: hours <br /> Is there standing water in well box? YES Above TOC Below TOC <br /> Is top of casing cut level? NO <5C]�3 If no, see remarks <br /> Is well cap sealed and locked? NO VZ5 If no, see remarks <br /> Height of well casing riser (in inches) : .6 <br /> Well cover type: 8" UV 12" UV 12" EMCO 8" BK <br /> 12" BK 12" DWP 12" CNI 36" CNI_ V Other <br /> General condition of wellhead assembly: Excellent 522 Fair Poor <br /> Purging Equipment: 2" disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer _Centrifugal pump <br /> Sampled with: Disposal bailer: Teflon bailer: <br /> Well Diameter: 2" 4" 6" 8" <br /> Purge Vol. Multiplier: 0. 16 0. 65 1. 47 2 . 61 gal/ft. <br /> Initial Measurement Recharge Measurement <br /> Time: Time: ;-,t7 Calculated purge: � a <br /> Depth of well: r3. 3 S Depth to water: 6 f1.3 � Actual purge: <br /> a '� �� <br /> Depth to water: 6!33 - <br /> Start purge: Sampling time: <br /> Time Temp. E.C. pH Turbidity Volume <br /> 7 <br /> 11,03 71.E 0� 3 <br /> /1I X06 l! j d <br /> Sample appearance: Lock: �ti <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 2" Locking Cap: Lock #3753 : 7/32 Allenhead: <br /> 4" Locking Cap: Lock-Dolphin: 9/16 Bolt: <br /> 6" Locking Cap: Panned Allenhead (DWP) : <br />. Remarks: <br /> Signature: <br />